Healthcare Provider Details

I. General information

NPI: 1316511744
Provider Name (Legal Business Name): JARED HARGETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DRIVE, SUITE 110
BIRMINGHAM AL
35243-3524
US

IV. Provider business mailing address

9005 HARGETT ST
KIMBERLY AL
35091-2410
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax:
Mailing address:
  • Phone: 205-641-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number133654
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: